Provider Demographics
NPI:1558683664
Name:SITE 4 SIGHT, INC
Entity Type:Organization
Organization Name:SITE 4 SIGHT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARLOS BONILLA
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:954-458-2268
Mailing Address - Street 1:645 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5344
Mailing Address - Country:US
Mailing Address - Phone:954-458-2268
Mailing Address - Fax:954-458-2278
Practice Address - Street 1:645 W HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5344
Practice Address - Country:US
Practice Address - Phone:954-458-2268
Practice Address - Fax:954-458-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3655152W00000X
FLOE1792332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE201AMedicare PIN